Preterm Labour Flashcards
When would you offer a choice between vaginal progesterone and cuz cerclage
Hx of preterm birth or mid-trimester loss between 16 and 34 weeks
AND
Cx length < 25mm between 16 and 24 weeks
When would you offer only vaginal progesterone
Cx length <24mm
AND
no Hx of preteen birth or mid trimester loss
When would you consider cervical cerclage
Cx length <25mm at 16-24 weeks
AND
Hx of Cx trauma
Or
Hx of PPROM in previous pregnancy
What investigations would you do in suspected PROM, no liquor seen
Insulin-like growth factor binding protein-1
Or
Alpha microglobulin 1 test
Results should be interpreted within clinical context
Management of PPROM
Erythromycin 250mg qds for 10 days
Penicillin second line
When would you consider rescue cerclage
16-27+6
Dilated Cx, exposed & unruptured membranes
Management of suspected preterm labour <29+6
Treat as preterm labour
Nifedipine tocoloysis
Management for suspected preterm labour >30 weeks
Cx length if available
<15mm treat
If not available
FFN
>50ng/ml treat
If not available offer treatment
At what gestation would you consider tocolysis
24-25+6
Intact membranes and suspected preterm labour
At what gestation would you offer tocolysis
26 - 33+6
Intact membranes and suspected preterm labour
What should be offered as tocolysis
Nifedipine
If contraindicated or unavailable oxytocin receptor antagonists
Do not offer betamimetics
Regarding preterm delivery
When would you consider maternal corticosteroids
Suspected or established preterm labour or planned delivery or PPROM
24-25+6
Or
34-35+6
Regarding preterm delivery
When would you offer maternal corticosteroids
Suspected or established preterm labour or planned delivery or PPROM
26-33+6
When would you offer magnesium sulphate for neuro-protection
Established preterm labour or planned delivery within 24 hours
24-29+6
When would you consider magnesium sulphate for neuro-protection
Established preterm labour or planned delivery within 24 hours
30-33+6
How is magnesium sulphate for Neuro protection given
What monitoring is required
4g IV over 15 min
1g per hour for 24 hours or until delivery
Check RR, BP and reflexes four hourly
Below what gestation should fetal scalp monitoring not be used
At what gestation is discussion requires
<34 weeks
34-36 weeks
Below what gestation should FBS not be used
At what gestation is discussion required
<34 weeks
34-36 weeks
When should elective Caesarean section for breech be considered
26-36 weeks
If preterm babies are stable and there is no significant maternal bleeding, when should the cord be cut
> 30 seconds
<3 minutes
Position baby at level of cord or above it
Preterm births account for what % of live births
7.3%
What is the single biggest cause of neonatal mortality and morbidity in the U.K.
Preterm birth
